Agenda item

Miles Scott (Chief Executive, Maidstone & Tunbridge Wells NHS Trust) was in attendance for this item.

(1)       The Chair welcomed Mr Scott to the Committee and asked him to introduce himself. Mr Scott explained that he joined the Trust as Chief Executive four months ago from NHS Improvement. He stated that he had worked in the NHS for over 30 years and had been Chief Executive of St George’s University Hospitals Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust and Harrogate and District NHS Foundation Trust.

(2)       He presented a series of slides which provided an introduction to the Trust; updates on the Trust’s financial and operational performance; and recent CQC inspection.Mr Scott stated that the Trust had two main roles: it provided a range of general hospitals services to a population of 650,000 residents in West Kent and East Sussex and specialist cancer services to 2 million people across Kent and Sussex via the Kent Oncology Centre. He noted that both Maidstone and Tunbridge Wells Hospitals provided accident & emergency and general medical services; Maidstone provided cancer and complex surgery services whilst Tunbridge Wells provided trauma, maternity and children services.

(3)       Mr Scott explained that the Trust was placed in Financial Special Measures (FSM) in July 2016. NHS Improvement appointed a Finance Improvement Director (FID) who identified a potential deficit of £42.7 million, which equated to 10% of turnover at the time, and worked with the Trust to construct a financial recovery plan which helped to put the Trust into the position whereby the activity growth was now greater than the pay-bill and the underlying deficit had reduced to £20 million in the last financial year. Mr Scott informed the Committee that through the combination of productivity improvements and alignment of non-recurring measures, the Trust was on track to meet its control total for the current year.

(4)       In terms of operational performance, Mr Scott drew the Committee’s attention to six key points:

1.    There were no reported MRSA cases and only 25 cases of reported clostridium difficile at the Trust in the last year;

2.    Low numbers of avoidable pressure ulcers and patient falls were two key indicators of safe nurse staffing levels;

3.    There was a 10% increase in emergency admission in one year across the Trust which impacted on its ability to carry out planned work.

4.    There was an increase in Referral to Treatment Times (RTT) due to planned cases being displaced by emergency cases and pressures around cancer service access standards. In response to this, the Trust had devised a programme to increase elective surgery through increased productivity in operating theatres

5.    Improvements to access to cancer services were required particularly around early diagnosis. He noted that Kent ranked 19^th out of 19 areas in England for access to cancer services.

6.    As with other NHS Trusts, Maidstone and Tunbridge Wells NHS Trust faced a number of pressures in terms of staffing and work was continuing to be done to tackle those.

(5)       Mr Scott explained that the Trust had been inspected by the CQC and there had been a significant shift in the individual ratings between 2015 and 2018 inspections. He stated that the Trust was well placed to move up through the ratings as further services were inspected. He noted that the CQC had made a series of recommendations which the Trust was working through to address.

(6)       In response to a question about the impact of budget on hospital services, Mr Scott advised Members that regardless of money, the Trust would not be able to staff more beds. Instead, the Trust was finding new ways to develop services within hospitals and the local community that helped to get patients back into their own home more rapidly such as the new Frailty Unit at Tunbridge Wells Hospital.

(7)       Members enquired about the PFI funding for Tunbridge Wells Hospital and whether the Trust had been able to renegotiate its fixed PFI charges. Mr Scott explained that any new hospital would have cost more in terms of capital in comparison to operating the old hospital. Mr Scott noted that the FID had not recommended renegotiating the PFI charges in 2016 but acknowledged that it may be timely for it to be reviewed.

(8)       Members asked about the Trust’s ability to reduce fixed costs and the increased rate of serious incidents and emergency department attendance. Mr Scott stated there had been a reduction in costs through the use of generic drugs and a reduction in blood transfusion charges due to improved measures to conserve patient fluids and reduce internal bleeding. He reported that clinical savings were the Trust’s biggest targets. Mr Scott explained that the increased rate of serious incidents was positive; it showed that staff felt confident to report incidents and enabled the Trust to make improvements, mitigate risks and be held to account. Mr Scott stated that it was important to ensure that as soon as people presented at an Emergency Department, staff were able to respond quickly and proportionately and identify the correct pathway of care. He supported streamlining processes, such as encouraging people to use the telephone or internet as the first point of call for concerns regarding their health care.

(9)       Members enquired about the holes in theatre walls, safeguarding training and appraisals which had been identified in the CQC inspection report. Mr Scott stated that the hole referred to plaster damage in a wall caused by a trolley bashing into it at Maidstone Hospital which had been fixed. He noted that Maidstone Hospital had been well maintained and the condition of the hospital was much better in comparison to Wexham Park Hospital, Slough which had been built at the same template. Mr Scott acknowledged that when the Trust experienced high levels of demand, training such as safeguarding came under pressure. Mr Scott highlighted that the Trust’s appraisal rate was at 90% which was positive for an NHS organisation.

(10)     Members asked about complaints handling, ambulance handovers and staff turnover.  Mr Scott acknowledged that the process for responding to complaints was not at the desired standard. He assured the Committee that work was being done to improve the timeliness and quality of responses and was being overseen by the Chief Nurse.  Mr Scott reported that handover delays at the Trust were lower than at other trusts and SECAmb were happy with how the Trust transferred patients.  He noted that in the last year rapid assessment and treatment areas had been implemented along with Fit2Sit for patients who did not need to be on a trolley.  Mr Scott noted that the Maidstone and Tunbridge Wells NHS Trust had historically had a lower turnover rate compared to neighbouring hospitals in Kent, however, the Trust could not be complacent with its efforts. Tunbridge Wells Hospital had experienced issues around the cost of accommodation for its staff and was in discussions with the Borough Council about the creation of more affordable key worker accommodation.

(11)     The Chair enquired about the actions being taken to improve access to cancer services. Mr Scott explained that for each tumour type, the Trust was investing in the front-end of the pathway to ensure diagnostics were completed within a quicker timeframe. As the cancer centre for Kent, the Trust was aware of the complexity of individual cases and the importance of tracking patients on an individual basis. He stated the Trust was planning to deliver the national standards by the end of the financial year.

(12)     RESOLVED that the report on Maidstone & Tunbridge Wells NHS Trust be noted and the Trust be requested to provide an update at the appropriate time.